P3B150: Social Determinants of Health Impact COVID-19 Vaccine Uptake in Underserved Children: Evidence from the Florida Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT) Cohort Study

Background: The COVID-19 pandemic exacerbated health inequities in marginalized U.S. communities resulting in increased hospitalization and mortality. Despite widespread advocacy for COVID-19 vaccination by the World Health Organization and the Centers for Disease Control and Prevention for all children ages 6 months or older, the pediatric population of Florida continues to struggle with vaccination coverage. In South Florida, there is a significant percentage of children belonging to immigrant families, that continues to grow as migration trends steadily increase. In the present study, we examine the association between social determinants of health (SODH) and COVID-19 vaccine uptake to inform community-based interventions and health promotion strategies within this vulnerable pediatric population.

Methods: Data was collected from the ongoing PROTECT cohort study, consisting of children aged 6 months to 17 years (n=347) in South Florida recruited between September 2021 and September 2022. Health survey data collected at enrollment including sex, age, gender, race, ethnicity, income, education, language, and health insurance stratified by COVID-19 vaccination status was tabulated (Table 1). Participant vaccination status was categorized as unvaccinated, partial primary series (1 doses), or complete primary series (at least 2 doses). Univariable and multivariable ordinal logistic regression models estimated the association between SDOH and COVID-19 vaccine receipt (Table 2).

Results: Among 347 participants, 58.5% remained unvaccinated throughout the duration of the study. Compared to children with complete COVID-19 primary vaccine series, a significantly greater number of unvaccinated children were 5-11 years (25.7% vs 18.4%; p<.0001), white race (37.2% vs 26.7%; p=.0126), Hispanic ethnicity (37.2% vs 25.0%; p=.0129), have health insurance (40.1% vs 27.8%; p=.0002), preschool/kindergarten educational-level (24.4% vs 7.4%; p=.005), and have household income of $150,000 (13.9% vs. 12.0%; p=.0198, Table 1).
Children who were 6-months to 4-years old vs 5-11 years old (adjusted Odds Ratio (aOR)=0.14; 95% Confidence Interval(CI): [0.04-0.53]), Hispanic/Latino ethnicity vs non-Hispanic/non-Latino (aOR=0.26; 95%CI:[0.12-0.60]), uninsured vs insured (aOR=0.22; 95%CI:[0.08-0.64]), and those with household income $25,000 to <$50,000 vs >$100,000 (0.18; 95%CI:[0.06-0.53]) were significantly less likely to pursue vaccination. Children of Black/African American race vs white race (aOR=7.40; 95%CI:[2.26-24.2]) and those who prefer speaking Spanish vs English (aOR=3.80; 95%CI:[1.28-11.29]) were significantly more likely to undergo vaccination.

Conclusion: COVID-19 vaccination status among South Florida pediatric participants was significantly associated to age group, race, ethnicity, insurance status, educational attainment, and household income. Given the disparities in morbidity and mortality resulting from COVID-19 and the role children play in the transmission of the disease, results suggest that future efforts to increase COVID-19 vaccination should focus on addressing key social determinants thereby increasing vaccine equity and enabling long-term control over SARS-CoV-2 infections.